低位和中高位直肠癌手术方式、并发症及预后比较

Comparison of operative methods, postoperative complications and prognosis of patients with low rectal cancer and middle-high rectal cancer

目的比较低位直肠癌和中高位直肠癌患者的手术方式、术后并发症及预后。方法将76例直肠癌患者根据肿瘤位置不同分为低位直肠癌组和中高位直肠癌组,分别为46例和30例。回顾性分析两组患者的手术方式、术后并发症、预后及相关影响因素。结果低位直肠癌组以Miles术(76.1%)为主,而中高位直肠癌组以Dixon术(80.0%)为主,差异具有统计学意义(P<0.05)。低位直肠癌组术后并发症以输尿管损伤、排尿功能障碍及性功能障碍为主,而中高位直肠癌组则以肠梗阻和下肢静脉血栓为主,差异均具有统计学意义(均P<0.05)。低位直肠癌组2年生存率(41.3%)低于中高位直肠癌组(66.7%),差异具有统计学意义(P<0.05)。淋巴转移是影响直肠癌预后的独立危险因素(P<0.05)。结论直肠癌肿瘤位置不同,其手术方式、术后并发症及预后均有差异,淋巴转移是影响其预后的独立危险因素。

Objective To compare the operative methods, postoperative complications and prognosis of patients with low rectal cancer and middle-high rectal cancer. Methods Seventy-six patients with rectal cancer were divided into the low rectal cancer group(n=46) and middle-high rectal cancer group(n=30) according to the location of the tumor. The operative methods, postoperative complications, prognosis and related influencing factors between the two groups were analyzed retrospectively. Results Miles surgery was mainly performed in the lower rectal cancer group(76.1%), while Dixon surgery was mainly performed in the middle-high rectal cancer group(80.0%), and the difference was statistically significant(P<0.05). Main postoperative complications in the lower rectal cancer group were ureteral injury, urinary dysfunction and sexual dysfunction, while those in the middle-high rectal cancer group were the intestinal obstruction and venous thrombosis, and the difference was statistically significant(all P<0.05). The 2-year survival rate of the low rectal cancer group was significantly lower than that of the middle-high rectal cancer group(41.3% vs 66.7%, P<0.05). Lymph node metastasis was an independent risk factor for the prognosis of rectal cancer(P<0.05). Conclusion The operative methods, postoperative complications and prognosis of rectal cancer vary with the location of the tumor. Lymph node metastasis is an independent risk factor for the prognosis of rectal cancer.